• S.

    616

    INHIBITIONS, SYMPTOMS AND ANXIETY

    BY SIGMUND FREUD

    Our verbal usage permits us, in describing pathological phe-
    nomena, to distinguish between inhibitions and symptoms,
    although without attaching very much importance to the dis-
    tinction. If we did not encounter cases of which we are forced
    to say that they exhibit only inhibitions, without any symptoms,
    and if we did not wish to know the reason for this, we should
    scarcely think it worth while to demarcate the concepts “inhi-
    bition” and “symptom”.

    The two concepts are not rooted in the same soil. Inhibition
    relates specifically to function and does not necessarily denote
    something pathological; a normal restriction or reduction of a
    function may also be termed an inhibition of it. To speak of
    a symptom, on the other hand, is tantamount to indicating a
    morbid process. Thus an inhibition may also be a symptom.
    Our habits of speech are such, then, as cause us to speak of an
    inhibition when a simple reduction of function is present, of
    a symptom when it is a question of an unusual alteration of
    function or of a new modality thereof. In many cases it seems
    to be perfectly arbitrary whether one emphasizes the positive
    or the negative aspect of a pathological process, whether one
    terms its result a symptom or an inhibition. All this is of little
    real interest, however, and the way in which we have formu-
    lated our problem proves not to be a very fruitful one.

    Since inhibition is by definition so intimately bound up with
    function, it is but a short step to the idea of investigating the
    various ego functions with reference to the forms in which
    disorder of these functions is manifested in the various neurotic
    affections. We select for this comparative study the following:
    the sexual function, eating, locomotion, and vocation.

    (a) The sexual function is subject to a great multiplicity of
    disturbances, the majority of which have the character of
    simple inhibitions. These are grouped together as psychic
    impotence. The execution of the sex act presupposes a very

  • S.

    617

    complicated sequence of events, any one of which may be the
    locus of disturbance. The principal loci of inhibition are in
    men the following: a turning aside of the libido at the initi-
    ation of the act (psychic displeasure (Unlust)), absence of
    physical preparedness (non-erectibility), abbreviation of the
    act (ejaculatio præcox), which may equally well be described as
    a positive symptom, suspension of the act before its natural
    culmination (absence of ejaculation), the non-occurrence of the
    psychic effect (of the pleasure sensation of orgasm). Other
    disturbances result from the association with the sexual func-
    tion of specific conditions of a perverse or fetishistic character.

    We cannot long escape noting a relationship which inhi-
    bition bears to anxiety. Many inhibitions are an obvious
    renunciation of function, because the exercise of the function
    would give rise to anxiety. Outright dread of the sexual func-
    tion is frequent in women; we catalog this with hysteria, as we
    do also the defensive symptom of disgust which arises originally
    as a reaction following upon the sexual act as passively experi-
    enced, but later appears in relation to the mere idea of it. A
    great many compulsive acts likewise plainly serve as a precau-
    tion and an assurance against sexual experience, and are there-
    fore phobic in their character.

    This does not add much to our understanding, however; one
    sees merely that the most varied means are employed to disrupt
    function, as: (1) the mere turning aside of libido, which seems
    most easily to produce what we call pure inhibition; (2) impair-
    ment of the execution of the function; (3) the rendering it
    difficult through the imposition of special conditions, and its
    modification through diverting it to other aims; (4) its preven-
    tion by means of precautionary measures; (5) its discontinuance
    by the development of anxiety, when the initiation of the func-
    tion can no longer be prevented; finally, (6) a subsequent
    reaction of protest against the act and a desire to undo it if it
    has actually been carried out.

    (b) The most frequent disturbance of the nutritive function
    is anorexia through withdrawal of libido. Increased desire to
    eat is also not infrequent; there is also a compulsion to eat,

  • S.

    618

    motivated by a fear of starvation, which has been little studied.
    As a hysterical defense against eating, the symptom of vomiting
    is familiar. Refusal to eat as a reaction to anxiety belongs
    among the psychotic patterns of behavior (delusions of
    poisoning).

    (c) Locomotion is inhibited in many neurotic states by
    antipathy to walking and weakness in walking; the hysterical
    disability makes use of motor paralysis of the motor apparatus
    or creates a specific suspension of this one function of the latter
    (abasia). Particularly characteristic are the difficulties of loco-
    motion brought about by the interpolation of definite condi-
    tions as prerequisites, the non-fulfilment of which evokes
    anxiety (phobia).

    (d) Inhibition in the field of occupation, which so often
    becomes a matter for treatment as an isolated symptom, is
    evidenced in diminished pleasure in work, or its poor execu-
    tion, or such reactive manifestations as fatigue (vertigo, vomit-
    ing) if the subject forces himself to go on working. Hysteria
    compels the suspension of work by producing paralysis of
    organs and functions, the existence of which is incompatible
    with the carrying on of work. The compulsion neurosis
    interferes with work by a continuous distraction of the
    attention and by loss of time in the form of procrastination and
    repetition.

    We might extend this survey to include still other functions,
    but we should not expect to profit by so doing. We should
    not get beyond a mere scratching of the surface in this way.
    Let us therefore decide upon a formulation which will leave
    the concept of inhibition with as little of the mysterious about
    it as possible. Inhibition is the expression of a functional
    limitation of the ego–a limitation which may have a large
    variety of causes. Many of the mechanisms of this renuncia-
    tion of function, and its general trend, are well known.

    In the case of certain particular inhibitions the trend
    expressed is rather easily recognized. When playing the
    piano, writing, and even walking are made the subject of
    neurotic inhibition, analysis reveals as the basis thereof an

  • S.

    619

    excessive erotization of the organ involved in the function in
    question, the fingers and the feet. We have obtained the
    impression that as a rule the ego-
    function of an organ is
    impaired whenever its erogeneity, its sexual significance, is
    increased. The organ then behaves–if we may hazard a some-
    what scurrilous metaphor–like a cook who refuses to stay in
    the kitchen because the master of the house has embarked
    upon an affair with her. If writing–which consists in allow-
    ing a fluid to flow out from a tube upon a piece of white paper–
    has acquired the symbolic meaning of coitus, or if walking has
    become a symbolic substitute for stamping upon the body of
    Mother Earth, then both writing and walking will be abstained
    from, because it is as though forbidden sexual behavior were
    thereby being indulged in. The ego renounces these func-
    tions proper to it in order not to have to undertake a fresh
    effort of repression, in order to avoid a conflict with the id.
    Other inhibitions evidently subserve a desire for self-punish-
    ment, as for example not infrequently those in the sphere of
    vocational activity. The ego dares not do certain things
    because they would bring an advantage and a success which
    the strict superego has forbidden. Thereupon the ego
    renounces these activities also, in order not to become involved
    in conflict with the superego.
    The more general inhibitions of the ego follow a simple
    mechanism of another character. When the ego is occupied
    with a psychic task of special difficulty, as for example by grief,
    a wholesale suppression of affect, or by the necessity for holding
    constantly mounting sexual fantasies in check, it becomes so
    impoverished with respect to the energy available to it that it
    is driven to restrict its expenditure in many places at the same
    time, like a speculator who has tied up his money in his various
    enterprises. An instructive example of such an intense but
    temporary general inhibition I was able to observe in a patient
    with compulsion neurosis who was overcome by a paralyzing
    fatigue of one to several days’ duration on occasions which
    obviously should have provoked an outburst of rage. From
    this point of departure there must be found a path to the

  • S.

    620

    understanding of generalized inhibition whereby we may char-
    acterize the depressive states and the most severe of these,
    melancholia.

    One may therefore say of inhibitions, in fine, that they repre-
    sent a limitation and restriction of ego functions, either pre-
    cautionary or resulting from an impoverishment of energy.
    It is now easy to see wherein an inhibition differs from a symp-
    tom. A symptom can no longer be described as a process taking
    place either in or around the ego.

    II

    The general principles of neurotic symptom formation have
    long been studied and have been laid down in incontestable
    fashion, one may hope. Symptoms are supposed to be an indi-
    cation of and substitute for an unachieved instinctual grati-
    fication; they are, that is, a result of repression. Repression
    proceeds from the ego, which, possibly at the command of the
    superego, does not wish to be a party to an instinct cathexis
    originating in the id. Through repression the ego accom-
    plishes the exclusion from consciousness of the idea which was
    the carrier of the unwelcome impulse. Analysis frequently
    demonstrates that the idea has been retained as an unconscious
    formation. So far the matter is clear enough, but presently we
    encounter unsolved difficulties.

    The description we have given heretofore of the process
    involved in repression has expressly emphasized the result it
    achieves in excluding something from consciousness, but has
    left other points open to doubt. The question arises as to the
    fate of the instinctual impulse generated in the id which strives
    for gratification. The answer has been an indirect one; it was
    to the effect that through repression the pleasure that was to
    be expected in gratification was converted into unpleasure
    (Unlust); whereupon one was confronted by the problem of
    how unpleasure can be the result of the gratification of an
    instinct. We hope we shall clarify the situation if we lay it
    down definitely that in consequence of repression the excitation
    arising in the id altogether fails of discharge: the ego succeeds